The fourth decade of the HIV and AIDS epidemic has barely begun, yet we can already see how it will differ from the three already past. The word zero could make 2012 a memorable year if it truly informs and directs our efforts in every sector of society and every region of the world.
Getting to zero means working together to create a world with zero new HIV infections, zero discrimination, and zero AIDS-related deaths. We have articulated specific, measurable targets for 2015 in the United Nations 2011 Political Declaration on HIV/AIDS, identified steps required to achieve them and inspired world leaders to speak openly of a prospect that only recently seemed far-fetched. We have built a foundation from which we can now credibly envision an AIDS-free generation. The challenge is to stay focused despite new challenges. After nearly a decade of resource growth, we have entered a period of shrinking and uncertain commitments. To get to zero we must find ways to get broader access and better outcomes with available resources.
AN INTEGRATED RESPONSE FOR BETTER RESULTS
The AIDS response is inseparable from broader health and human development efforts. Integration of key services, optimizing synergies and creating linkages are necessities in an era of declining resources. Integration is paying huge returns in prevention of tuberculosis (TB) deaths among people living with HIV. For example, through a Médecins Sans Frontières (MSF) programme to integrate services for TB and HIV in Lesotho, some 81% of co-infected patients received antiretroviral therapy in the one-stop service sites, versus 24% nationally, and their death rates varied accordingly.
REVOLUTIONIZING PREVENTION EFFORTS
We must work harder to empower people whose life circumstances place them at increased risk of HIV. Social media networks push youth participation in the AIDS response to a whole new level. With the launch of CrowdOutAIDS.org, UNAIDS recently involved more than 5000 young people around the world in an effort to crowdsource a new youth strategy for UNAIDS in real-time.
But it's not just young people we need to reach. As of 2009, only 26% of countries had set HIV prevention goals for reaching sex workers, only 30% had set targets for reaching people who use drugs and just 18% had them for men who have sex with men. Even fewer countries report data on key populations, and HIV prevention services for these groups are often minimal.
While urging people to avoid risk, we can now also use technology to help reduce the risk of HIV transmission. For example, antiretroviral treatment can help prevent sexual transmission of HIV, just as it reduces the risk of HIV transmission from mother-to-child. Research findings reported last year confirmed that consistent use of antiretroviral drugs can reduce—by 96%—the risk that a person living with HIV will pass the virus to a sexual partner. By expanding voluntary testing and treatment, we could reduce a whole community's viral load and slow transmission rates, even where HIV prevalence is high.
A decade ago, it was hard to imagine that 6.6 million people would ever receive antiretroviral therapy in low- and middle-income countries. Reaching that milestone has been one of the greatest achievements in the history of public health. Yet 7.6 million people eligible for treatment still lack access to these lifesaving drugs. The need is growing even as the rate of new infections declines. We need a second phase of the treatment access revolution—this time to work with the pharmaceutical industry to continue the quest for better and smarter HIV medicines and point of care solutions. We have to join forces to make HIV treatment, care and support simple to deliver, long-lasting and efficient, and to break down barriers for faster scale-up.
GLOBAL SOLIDARITY AND NEW AFRICAN LEADERSHIP
Global investments in the AIDS response have increased 50-fold in just 16 years—from US$ 300 million in 1996 to approximately US$ 15 billion today. We would not be where we are today without the massive commitments of the United States of America through PEPFAR, of small and large donors, domestic investments by countries and the catalytic impact of the Global Fund. Yet the needs still exceed available resources, and the surge has stalled with international support now declining for the first time in a decade (from US$ 7.6 billion in 2009 to US$ 6.9 billion in 2010). Last year, the Global Fund was forced to cancel its next round of grants when donors fell short of their funding commitments. We must call on wealthy countries to honour their commitments while, at the same time, building a more balanced, sustainable response. We must tap on local resources and ingenuity, and ensure that every investment is well targeted and managed.
For affected countries to gain more control over the AIDS response, a more balanced partnership with international partners is vital, including long-term predictability of investments combined with leadership and commitment by growing African investments and innovative financing. In addition, access to new, quality medicines should be accelerated through the creation of an African Drug Regulatory Agency. Today, 80% of the ARVs consumed in Africa are manufactured in India, where patent laws allow manufacturers to produce low-cost generic versions of patented pharmaceuticals. African countries could legally meet their own medical needs by manufacturing the same drugs domestically. African governments can foster local competencies by creating a supportive policy environment.
GIVING VOICE TO THE VOICELESS
Globally, governments cite stigma as one of the greatest impediments to accelerated progress in the AIDS response. Stigma and discrimination deny people the tools they need to protect themselves and their communities, and they deny care and treatment to people living with HIV. Throughout the world, fear and social disapproval increase the vulnerability of mobile populations, prisoners, adolescents who practice high-risk behaviour and people in humanitarian settings. Such discrimination deepens social marginalization, increases the risk of harassment or violence and inhibits communities from mobilizing to address the epidemic.
The positive developments in the global AIDS response have unfolded against a complex backdrop: a global economic crisis, the first-ever reduction in international AIDS funding and the call of the UN Secretary-General to better control costs within the UN system. To deliver more effective support to countries, and to respond to the need for greater efficiency and effectiveness, an organizational review of the UNAIDS Secretariat was initiated to ensure a stronger and more focused UNAIDS that will deliver results faster, smarter and better.
If 2012 is to be the memorable year we all want for the AIDS response, then I must count on you—our partners in solidarity; our partners for innovation, integration and implementation.